Download Ultrasound Ablation in Advanced Pancreatic Cancer Patients – What

PANCREAS
ISSN 2471-142X
Opinion
*
Corresponding author
Dobromir Dimitrov, MD, PhD
Surgeon (Consultant) in Surgery
Department St. Marina Hopsital
Medical University-Pleven, Bulgaria
E-mail: [email protected]
Volume 1 : Issue 1
Article Ref. #: 1000POJ1103
Article History
Received: November 11th, 2015
Accepted: November 23rd, 2015
Published: November 24th, 2015
Open Journal
http://dx.doi.org/10.17140/POJ-1-103
Ultrasound Ablation in Advanced
Pancreatic Cancer Patients – What should
be the Next Step?
Dobromir Dimitrov1*, Hyuliya Feradova1, Milka Marinova2 and Zhou Kun3
Surgeon (Consultant) in Surgery Department St. Marina Hopsital, Medical University-Pleven,
Bulgaria
2
Department of Radiology, Medical School & Hospital, University of Bonn, Germany
3
Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
1
To the Editor,
Citation
Dimitrov D, Feradova H, Marinova
M, Kun Z. Ultrasound ablation in advanced pancreatic cancer patients
– what should be the next step? Pancreas Open J. 2015; 1(1): 7-8. doi:
10.17140/POJ-1-103
In the last decades the treatment for many diseases has changed dramatically. Open
surgery procedures with high morbidity and complication rates, suboptimal clinical results
based on large impairment for the patients were replaced by drug treatment or minimally invasive techniques. Examples such as interventional cardiology procedures in acute myocardial
infarction, interventional endoscopies in the treatment of hepato-biliary tract diseases, eradication of Helicobacter pylori for gastric ulcer using drugs are good evidence that the words of
William Osler “Diseases that harm require therapies that harm less” are valid now-a-days.1
Pancreatic Cancer (PC) is one of the most aggressive malignant diseases which survival rate, clinical results and treatment has not improved substantially in the past 40 years.
Radical surgery is still the only curative method for pancreatic cancer in early stage. Estimated,
only 20% of all cases with PC in early stage are suitable for surgical resection at the time
of diagnosis, still the expected 5-year survival rate remains 5-20%. The other 80% of cases
with advanced PC (including locally and systemically advanced pancreatic cancer) have an
expected median survival time of only a few months and almost 0% of 5 year-survival rate
when effective alternative treatment methods are missing.2,3 In those patients with unresectable
advanced pancreatic cancer, there is still an urgent need for effective therapies that should not
only achieve sufficient local tumor control but also improve local symptoms and quality of life
as well as alleviate tumor-associated pain.
During the last decade, High Intensity Focused Ultrasound (HIFU) has been introduced as an innovative non-invasive method for thermal ablation of benign and malignant
solid tumors. For the last 15 years clinically approved medical devices using MRI- or US
(ultrasound) – guidance have been introduced.4 From 2003 to 2014, series of studies have been
published regarding Asian patients with advanced PC who were treated by US-guided HIFU
(USgHIFU) with good clinical results.4-6 Despite the great number of Asian studies, there are
only a few cases with Caucasian patients.7,8 All of these studies showed that USgHIFU ablation
is a feasible, safe and effective treatment for pancreatic cancer with a crucial clinical benefit for
the patients in terms of reduction of tumor volume and pain intensity.
Copyright
©2015 Dimitrov D. This is an open
access article distributed under the
Creative Commons Attribution 4.0
International License (CC BY 4.0),
which permits unrestricted use,
distribution, and reproduction in
any medium, provided the original
work is properly cited.
Pancreas Open J
All studies described in the literature include selected patients. Similar inclusion and
exclusion criteria are followed. All of the articles showed a single institution experience based
on case series. According to the levels of evidence developed by the Oxford Centre for Evidence-based Medicine for treatment, this represents level 4 and the grade of recommendation
for the physicians should be grade C (optional).9
Page 7
PANCREAS
ISSN 2471-142X
Open Journal
http://dx.doi.org/10.17140/POJ-1-103
In our centers, we have used USgHIFU device for non-invasive ablation of advanced PC. In our daily practice, we have
seen that the patients treated with USgHIFU and simultaneous chemotherapy experienced significant and lasting reduction of pain
intensity and tumor volume regression over time. Hence, patients’ quality of life was improved which emphasizes the clinical benefit
of USgHIFU. But we still don’t have results from prospective or retrospective multi-center studies. Case-control or cohort largescale studies are also missing. Hereby, we would like to emphasize on the acute necessity for large-scale prospective randomized and
multi-center clinical trials to evaluate the safety, clinical and long-term efficacy of USgHIFU treatment especially regarding overall
survival with or without simultaneous chemotherapy in the patients with advanced PC. After this step up on the evidence based
medicine stairs, more physicians and patients should be involved and the position of HIFU in future algorithms for the management
of locally advanced pancreatic cancer can be defined.
CONFLICTS OF INTERESTS
The authors declare that they have no conflicts of interest.
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